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Topic:

Adolescent Idiopathic Scoliosis

Issue:

Spine

Category:

​

Title:

Can We Control Lateral Shoulder Balance Through Proximal Thoracic Curve Correction in Lenke Type 2 Adolescent Idiopathic Scoliosis?

Author:

Lee, Hyung Rae MD; Hwang, Chang Ju MD, PhD; Seok, Sang Yun MD; Gwak, Hyun Wook MD; Cho, Jae Hwan MD, PhD; Lee, Dong-Ho MD, PhD; Lee, Choon Sung MD, PhD

Journal:

Journal of Pediatric Orthopaedics

Date:

January 2024

Reference:

44(1): p 28-36, DOI: 10.1097/BPO.0000000000002544

Level Of Evidence:

III

# of Patients:

151

Study Type:

Retrospective cohort study

Location:

Not specified

Summary:

This study investigates the hypothesis that proximal thoracic curve (PTC) correction does not directly affect postoperative lateral shoulder imbalance (PSI) in Lenke Type 2 adolescent idiopathic scoliosis (AIS) patients. The study also aims to identify the risk factors for PSI after corrective surgery.

Methods:

Inclusion Criteria: AIS patients with Lenke Type 2 who underwent corrective surgery with >2 years of follow-up. Exclusion Criteria: Not specified. Intervention: Surgical correction of Lenke Type 2 AIS with focus on PTC correction. Outcomes Measured: Postoperative lateral shoulder imbalance (PSI) measured by radiologic shoulder height (RSH) Directional changes in lateral shoulder balance at preoperative, postoperative, 1-month, and final follow-up Multivariate analysis to identify risk factors for lateral PSI Data Analysis: Repeated measures analysis of variance, univariate analysis, and multivariate analysis.

Exclusions:

Not specified

Results:

PSI at Final Follow-up: 29 out of 151 patients (19.2%) developed PSI. Shoulder Balance: Significant differences in shoulder balance between PSI (−) and PSI (+) groups at postoperative, 1-month, and final follow-up (P < 0.01 for all). Factors Correlated with RSH: Preoperative PTC, middle thoracic curve (MTC), and MTC correction were strongly correlated with RSH (P = 0.01, 0.03, and 0.04, respectively). PTC Correction and RSH: No significant correlation between PTC correction and RSH. Risk Factors for PSI: Smaller MTC curve and larger MTC correction rate were related to lateral PSI in multivariate analysis.

Conclusions:

The MTC curve and its correction have a greater influence on lateral shoulder imbalance in Lenke Type 2 AIS patients than the extent of PTC correction. Overemphasizing the correction of the PTC curve may not improve lateral shoulder balance. Surgeons should be cautious about overcorrecting the MTC curve, especially when it is smaller, to prevent lateral shoulder imbalance.

Relevance:

Limitations:

Perspective:

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